HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Iq4 ILUJO
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p Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Residential Re -Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 5908 Palm Dr, Fort Pierce, FL
Property Tax ID #: 3402-609-0573-000-9 Lot No. 3
Site Plan Name, INDIAN RIVER ESTATES-UNIT-08- BILK 68 LOT 3 (MAP 34/11S) Block No. 68
Project Name: 617960 Voegtlin
DETAILED DESCRIPTION OF WORK:
Re -Roof Atlas ProLam Shingle Hearthstone Gray FL16305-1310, 2 Layers Summit 60 FL21350-114, 35 SQ's, 6/12 Pitch,
New Electrical Meter Second Electrical Meter {Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator X Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor -
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Robert Voegtlin
Name: Donald Bouchard
Address: 5908 Palm Dr
Company: RoofClaim.com
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No. (772) 538-3274 E-
Address: 4800 N Federal Hwy Suite 209A
City: Boca Raton State: FL
Zip Code: 33431 Fax:
Phone No 561-282-9699
Mail: robertvoegtlin@att.net
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail permit@roofclaim.com
State or County License CCC1332081
IIIf value of construction is 2500 or more, a RECORDED Notice of Commencement is required. II
If value of HAVC is $7,504 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: _
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip:. Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER( CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please cohsu t with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording Your Notice of Commencement.
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Slita ure f Owner/ Lessee/Contrlactor as Agent for Owner
STATE OF FLORIDA
COUNTY OF St. Lucie
Sworn to (or affirmed) and subscribed befo�,e me of X Physical Presence or _ Online Notarization
this � day of EFA(Aa�l 12 0 by
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Name of person making statement.
Personally
Type ofldt
OR Produced Identification
(Signature of Nl5taly iublic- State of Florida)
Commission No. gibg3 (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
a.I"o„ KARYL GARNER
�4` 7s Notary Public -State of Florida
_ = Commission N GG 910439
My Commission Expires
SUPERVISOR PLANS I VEGETATION
REVIEW REVIEW REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW